مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و هفتم شماره 11 (پیاپی 227، بهمن 1398)

Skeletal muscle mass, which is regulated by a balance between muscle protein synthesis and degradation, is an important factor for movement to meet everyday needs, especially in pathological conditions and aging. The purpose of the present investigation was to compare the alterations of the gene expression involved in muscle protein synthesis and degradation signaling pathways induced by two exercise training protocols.

Eight weeks old Wistar rats have been assigned to the present experimental study, which was conducted from August 2018 to October 2018 at the animal laboratory of Tehran University. They were randomly divided into two resistance and endurance training groups and one control group, and run on a treadmill, 5 sessions per week for 8 weeks. 48 hours after the last exercise session, the rats in the two groups were anesthetized, and the dissected soleus muscles from euthanized animals were stored at -80° for RT-PCR and Western blot analysis later. Between-group differences were analyzed by the parametric and non-parametric tests for normally and non-normally distributed data respectively, at the significance level of α˂0.05.

Compared with the control group, mTORC1 gene expression was increased significantly just in the endurance group (P=0.022), whereas both endurance and resistance exercise protocols caused a significant increase in Rps6kb1 (P˂0.001 and P=0.001 respectively). In protein degradation pathway, although, FOXO3a did not alter significantly (P=0.463), eIF4Ebp1 gene expression was inhibited by both endurance and resistance exercise training protocols (P˂0.001 and P=0.001 respectively). The alterations of Rps6kb1 and FOXO3a gene expression were confirmed by Western blot analysis.

The results showed that the exercise training protocols of the present study had approximately similar effects on alterations of gene expression involved in skeletal muscle protein synthesis and degradation pathways. Therefore, application of the protocols may be considered to prevent or reduce the muscle atrophy in pathological conditions such as motor neuron disease, aging, and/or muscle strength improvement in athletes.

Gastric cancer (GC) is considered as one of the most common types of cancer worldwide with poor prognosis and generally limited treatment options. Recent studies have indicated that HER2, MDM2, MYC, MET, and TP53 play an important role in the development of gastric cancer. Therefore, the aim of this study was to evaluate the incidence of amplification/deletion of these genes in patients with gastric cancer.

In this descriptive study, a total of 37 gastric cancer tissue samples from GC patients including 23 males (62.2%) and 14 females (37.8%) referred to the Hematology-Oncology and Stem Cell Research Center of Shariati Hospital, Tehran, from March 2015 to February 2016 were evaluated. The patient's age at diagnosis ranged from 33 to 85 years (median: 65 years). The amplification pattern of HER2, MDM2, MYC and MET genes and TP53 deletion were investigated by fluorescence in situ hybridization (FISH) technique performed on 3 to 5 micron section obtained from formalin-fixed and paraffin-embedded cancer tissues.

The tumors were preferably identified at the distal stomach (54.05%) in comparison to tumors arising from the gastric cardia. The tumor size varied between 2 and 5 cm (average, 3.5 cm). Seven of the cases (19%) had advanced tumors at the time of diagnosis. HER2, MDM2, MYC, MET and TP53 copy number alteration were successfully determined in all samples obtained from the GC patients. HER2, MDM2, and c-MYC genes were amplified in 2 (5.41%), 1 (2.7%) and 3 (8.11%) of 37 patient samples, however, MET gene amplification and TP53 deletion were not observed in the obtained GC tissue samples. Co-amplification of HER2, MDM2, and MYC genes, and co-amplification of HER2 and MYC genes were detected in one patient.

The results of this study indicate the low frequency of MDM2, HER2 and MYC genes in gastric cancer patient and their copy number alterations may provide diagnostic and prognostic marker for GC patients.

Nausea and vomiting is one of the most common complications after the strabismus surgery. In this study, we evaluated the efficacy of atropine versus ondansetron administration on the incidence of postoperative nausea and vomiting and duration of recovery stay in patients undergoing this procedure.

In this case-control study, 90 patients between 3 to 30 years old who were candidates for elective strabismus surgery in Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran, from February to April 2019, were randomly divided into three groups (placebo, ondansetron and atropine group). Patients who had taken hypnotic drugs while entering the operating room were excluded. In all patients, after arriving into the operating room and installation of standard monitoring equipment and peripheral vein implantation, anesthesia was induced by receiving 0.05 mg/kg midazolam, fentanyl 1 μg/kg and propofol 2.5 mg/kg. After induction of anesthesia, placebo group was compared with ondansetron group and atropine group that received 0.1 mg/kg ondansetron and 30 µg/kg atropine, respectively. The rate of postoperative nausea and vomiting, duration of recovery stay and satisfaction of recovery nurses were recorded and compared between groups.

There was no statistically significant difference between the three groups in terms of mean age, weight, and gender. It seems that group matching is appropriate and there are no confounding factors for demographic variables. Administration of atropine and ondansetron significantly reduces the incidence of nausea and vomiting postoperatively and in recovery. There was no significant difference in the incidence of nausea and vomiting between the atropine and ondansetron groups. Duration of recovery stay was decreased after ondansetron and atropine administration versus control group. Postoperative laryngospasm and bronchospasm were not observed in any of the three groups after surgery and at the time of recovery. The satisfaction of recovery nurses in both atropine and ondansetron groups were higher than control group.

It seems that the administration of atropine as much as ondansetron can be effective in reducing the incidence of postoperative nausea and vomiting and the length of recovery stay in patients who undergoing strabismus surgery.

Cervix insufficiency is diagnosed based on a previous history of pregnancy loss in the second trimester, followed by painless cervical dilatation or premature rupture of the fetal membranes. Abnormal cervical tissue structural appears to be the cause of this complication. There are no diagnostic methods for cervical insufficiency before pregnancy, but magnetic resonance imaging (MRI), hysterosalpingography, and ultrasound can detect uterine anomalies that are risk factors for cervical insufficiency. Cerclage is known as a common procedure for prevention of the preterm labor, caused by cervix insufficiency. This study aimed to evaluate the prevalence of cerclage and it’s complications and prognosis based on the patient’s age, history of cervical insufficiency, history of preterm labor, history of miscarriage, curettage, and cervical and vaginal abnormalities.

A retrospective cohort study was conducted, including 65 patients, from March 2012 to March 2018, in Valiasr Hospital, Tehran, Iran. Data including the age, history of cervical insufficiency, history of abortion, history of cervix surgery and curettage, gestational age, presence of vaginal and cervical anomaly as well as complications such as bleeding and severe cervical pain and prognosis of cerclage were extracted.

In our study, 65 women who undergone cerclage were evaluated, the mean age of the participants was 28.4 years. Abortion was present in 27.7% of cases, 16.9% once, 7.7% twice and 3.1% three times. In 21.5% of cases, there was a history of curettage and 66.2% had a history of preterm labor. For 4.6% of the subjects, the length of cervix was under 10 mm. Gestational age at the end of cerclage was under 26 weeks in 5.8% of patients. The termination of pregnancy was higher in patients with lower gravida, and the termination of pregnancy was significantly higher in those who were not curetted (P= 0.001). There were no complications, and the prognosis is considered good, in case the termination is above 32 weeks. The birth weight mean was 3041.5 grams. According to our study, the failure of the cerclage is associated with previous history of dilation and curettage (D&C) and higher gravidity.

Putting all the results together, 80% of the cerclage, performed in our institution were successful, without any complications.

Health care associated infections (HAIs) are a class of infections that infect patients during hospital admissions and receive medical services. These infections occurs within 48 to 72 hours of admission and up to 6 weeks after discharge. Surveillance of device-associated infections (DAIs) in intensive care units (ICUs) is substantial in planning healthcare strategies. This study was conducted to determine the device-associated infections' burden and antimicrobial resistance patterns.

In this descriptive-analytic study, three common device-associated infections included central line-associated bloodstream infection (CLA-BSI), ventilator associated pneumonia (VAP), and catheter-associated urinary tract infection (CA-UTI), were assessed in intensive care units of Besat Hospital in Hamedan from April 2017 to April 2018. In order to determine the incidence of device-associated infections, the number of device-associated infection cases was calculated during the study period and divided into the number of device-days used. The device-days included all days of exposure to that device (vascular catheter, endotracheal tube (ventilator), or urinary catheter) in all patients in the study population.

Out of 1806 intensive care unit admitted cases, 168 patients (9.3%) were device-associated infection with distribution of 92 cases (55%) of ventilator-associated pneumonia (VAP), 56 cases (34%) of catheter-associated urinary tract infection (CA-UTI) and 20 cases (11%) of central line-associated bloodstream infection (CL-BSI). The incidence of VAP, CA-UTI and CL-BSI was 44.7, 17.5, and 21.61 days, respectively. The most organisms were Acinetobacter (27.4%), Klebsiella (18.3%), Escherichia coli (E. coli) (15.4%). Vancomycin-resistant enterococcus (VRE) was 75%. Acinetobacter resistance to colistin and carbapenem was 16.8%. About half of Pseudomonas isolates were resistant to meropenem.

According to the present findings of this study, a high incidence of device-associated infections and resistant organisms in our intensive care units were documented, which represents a need to reinforce the preventive and control programs. Various results in different studies can be due to differences in the level of health care in different centers and countries.

Renal calculus with increasing prevalence and incidence in recent decades have the highest burden of urologic diseases. While preventive measures could significantly reduce the rate of recurrence, the amount of compliance with the preventive guidelines is unclear among urologists. This study was designated to evaluate the knowledge, attitude, and practice in kidney stones prevention among urologists for the first time in Iran.

This cross-sectional study was conducted on the participants of the 20th Iranian Urological Association Congress. The questionnaires included questions regarding demographics, educational and occupational information, knowledge, attitude, and practice of urologists in the field of kidney stones prevention. The questionnaires were designed according to the latest guideline of the European Association of Urology and previous studies. Scores related to the knowledge and practice were calculated based on the number of questions with correct answers. The response rate was also calculated. The correlation of knowledge and practice with background variables, including age, work experience, and time since graduation were assessed.

The total response rate was 18.08% (64 out of 354 distributed questionnaires). The mean age of the respondents was 47.25±10.20 and the mean work experience was 15.61±11.70 years. The mean knowledge and practice scores were 8.36±1.48 out of 11 and 4.44±1.45 out of 7 scores, respectively. A total of 96.2% and 73.4% of the urologists earned at least half of the knowledge and practice scores, respectively. There was no significant correlation between knowledge and practice scores (P=0.706). Work experience and time since graduation had a negative relationship with the knowledge scores (respectively, P=0.02 and P=0.026), and faculty membership had a positive correlation with the practice scores (P=0.022). Most respondents had an acceptable attitude regarding the effectiveness of stone prevention.

Although the study participants had good knowledge, attitude, and practice pattern regarding urinary stone prevention, their performance score was less than their level of awareness. However, we could not generalize the results to other urologists due to the low response rate of the study.

TRX training is a new training method that has beneficial effects on improving balance and strength. However, the role of these types of training on the factors associated with function and mitochondrial biogenesis is not understood. Therefore, the purpose of present study was to determine the effect of eight weeks of TRX training on serum levels of Peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α) and citrate synthase in overweight women.

All subjects gave written informed consent after a detailed description of the study procedures. The protocol of this study was approved by the Research Ethics Committee of Sport Sciences Research Institute (SSRI) in Iran. The present study was experimental and was conducted in Shahid Ghaffari women's club in Tehran under the supervision of Alzahra University from May 2018 to January 2019. For this purpose, 30 overweight women after primary alignment on basis of body mass index (25-30 kg/m2) were divided into two groups: control (n=14) and TRX training (n=16). The TRX training protocol was performed for eight weeks and 3 sessions per week, which included 6 main movements (squat, rear deltoid row, biceps curl, chest press, low row, rotational ward) that lasted 60 minutes per session. According to consideration the physical condition of each person, the subjects were free to modulate the exercise intensity by changing the body inclinations. Each exercise provided 4 sets of 12 repetitions separated by one-minute rest. Blood sampling was performed in two stages of pre-test and 48 hours after the last session of the exercise in overnight fasting state. After collection of serum samples, enzyme-linked immunosorbent assay (ELISA) method was used to measure serum levels of PGC-1α and citrate synthase.

The results showed that TRX training caused no significant change in the body weight and body mass index compared to the control group. In addition, TRX training increased significantly the serum levels of PGC-1α and citrate synthase compared to the pre-test and the control group.

The findings of the present study indicated that eight weeks of TRX training could increase serum levels of PGC-1α and citrate synthase in overweight women.

Curcuma longa generally known as turmeric includes curcuminoids and sesquiterpenoids as components, which are known to have antioxidative, anticarcinogenic, and anti-inflammatory activities. Iron, magnetite, and hematite as a micronutrient play an important role in physiological and chemical processes. Chitosan is a natural polymer derived from chitin and is recognized as versatile biomaterials because of their high biocompatibility, nontoxicity, and biodegradability to harmless products. The purpose of this research was to design synthesis and loading of nanocurcumin on iron magnetic nanoparticles modified with chitosan which is used as a targeted drug.

This laboratory research was conducted in Aja University of Medical Sciences from May to November 2017. Loading of nanocurcumin on iron magnetic nanoparticles modified with chitosan was done in two steps. In the first step, after preparing chitosan and iron magnetic nanoparticles, chitosan is placed as a coating polymer on surface of iron magnetic nanoparticles. In the next step, the final reaction is done by adding nanocurcumin on iron magnetic nanoparticles modified with chitosan. This causes nanocurcumin to penetrate into the polymeric layer core shell nanoparticles.

Findings of transmission electron microscope and scanning electron microscope images show structure, morphology, physicochemical and the presence of nanocurcumin layers on chitosan in nanoparticles with diameter of 20 nm well. In Fourier transform infrared spectroscopy (FTIR), the Fe-O peak indicates magnetic nanoparticles and peak of the O-H in nanocurcumin layers on chitosan. Energy dispersive X-ray spectroscopy spectrum showing iron, carbon, oxygen and nitrogen peaks confirms the presence of these elements in the final composition and shows that chitosan and nanocurcumin groups are well dispersed on iron magnetic nanoparticles. The nanocurcumin loaded at 450 nm wavelength was evaluated by ultraviolet-visible spectrophotometry.

Results of Fourier transform infrared spectroscopy (FTIR), field emission scanning electron microscope image, energy dispersive X-ray spectroscopy spectrum, transmission electron microscope image, vibrating sample magnetometer analysis indicated that nanocurcumin has been successfully loaded on iron magnetic nanoparticles modified with chitosan and can be used as a targeted drug.

Botulism is mostly caused by Clostridium botulinum neurotoxin which has been described as a bilateral symmetric descending flaccid paralysis. Preventing and responding to botulism outbreaks is a public health emergency. In this study, the disease is reported in a family.

In a case series study, during an outbreak, four members of a family with symptoms including paralysis, ptosis, blurred vision, diplopia, weakness, dysphagia, dry mouth, respiratory problems, vertigo, and lethargy, referred to Loghman Hospital of Tehran. Among the patients was an elderly woman and a pregnant woman. All clinical signs and symptoms of the patients were recorded daily in a researcher-made questionnaire from 27 August to 3 September 2018. At the time of admission, vital signs (pulse rate, respiration rate, and body temperature) of patients were stable and within normal limits. Following clinical suspicion of food-borne botulism in these patients, samples of the first two patients, including serum, stool, gastric secretions, and homemade whey were sent to the Botulism Laboratory of Microbiology Department of Pasteur Institute of Iran for the mouse bioassay.

Type A neurotoxin was detected in homemade whey after the mouse bioassay. Therefore, foodborne botulism was confirmed in patients with laboratory results. Patients included two men and two women with a mean age of 52.7 years old. The length of hospitalized days was between 2 and 6 days. Two of the patients were admitted to the intensive care unit (ICU). Patients under study were fully recovered with timely diagnosis of the disease, treatment with antitoxin, and supportive care.

When conscious patients referred to the hospital with symptoms of paralysis, foodborne botulism is an important differential diagnosis. On-time diagnosis and antitoxin treatment can prevent serious complications.

Hypereosinophilic syndrome is commonly found in various diseases such as allergic diseases, parasitic diseases, malignancies, etc. Fasciolosis may present with different clinical features, and it can make a difficult diagnosis of the disease. Laboratory manifestations of fascioliasis are eosinophilia. The purpose of this report was to introduce a child with hypereosinophilia that her diagnosis was fascioliasis.

The patient was a 3-year-old girl who was referred for prolonged fever (more than two weeks) and abdominal pain from another medical center, and she was hospitalized. In abdominal and pelvic ultrasound, splenomegaly was seen and in laboratory tests, she had hypereosinophilia. In the flow cytometry of bone marrow aspiration, the only finding was increased eosinophil level. Abdominal and thoracic a computerized tomography (CT) scans showed an increased size of para-aortic lymph nodes. On her examination, lymphadenopathy was present in the inguinal region. Therefore, a biopsy of an inguinal lymph node was performed to rule out lymphoma. Lymph node biopsy was negative for lymphoma. Fasciola serology was performed for the patient, and the stool exam was collected three times (for one day in between) to rule out parasitic disease, including Fasciola, etc. Due to weakly positive serology Fasciola hepatica, triclabendazole was started for the patient (it was given in two doses, 12 hours apart), despite the absence of Fasciola parasitic eggs in her stool. During hospitalization, the patient’s fever was stopped and by starting the use of mentioned drug, eosinophilia was reduced. The patient received a complete improvement in the follow-up.

In patients with hypereosinophilia, parasitic diseases such as fascioliasis should be considered even if the fecal specimen is negative for Fasciola eggs.